| NPI | 1497955975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 26451) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 25843) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2007-08-11 |